thoughts on socialized medicine

I like Yglesias’s idea:

I actually think there’s a very strong case on the merits for a limited form of socialized medicine. Which is to say that I think it would be smart for the government to directly provide a certain class of relatively cheap, not-very-interesting preventive services. You would have clinics in neighborhoods where medical personnel (mostly nurse-practitioners and dental hygenists, I would think) directly employed by the government could provide things like vaccinations, regular tooth cleaning, prostate exams, etc.

I’ve read recently that health results in areas where most of the medicine was provided by general practitioners (family doctors) rather than by a host of specialists were actually much better – longer life expectancy, lower costs, and so forth.  It makes sense, to me, to have a socialized plan that provides these sorts of general and preventative services.  So much can be done to limit health costs by simply having people in to see the doctor on a regular basis.

Beyond this, then, you have universal coverage – but not necessarily “socialized” – for everything else (specialists, surgeries, etc).   Some thoughts:

• I don’t think this should eliminate the option for consumers (or citizens, if you prefer to think of yourself that way) to buy or receive private insurance, but I do think that when it comes to health care, pretty much everything else – including political ideology – needs to take a back seat.  When people are getting sick and going bankrupt and can’t provide for their kids, who are also getting sick, and this cycle really gets going – well who really cares if you have to wait a little longer to see your doctor as long as you can see him and afford to see him?  This seems like a vital democratic (and Christian) prerogative.

• The private insurance market has not provided for everyone and it likely won’t.  That doesn’t mean it can’t continue to provide for some.  However, private markets will do a great deal in other areas.  Indeed, something often left out of this debate is the fact that health care is simply one small slice of all the myriad industries that private entrepreneurs manage.  If one were to take the health care question off the table – by, say, providing universal coverage – we would, at the end of the day, still be left with a primarily capitalist economy.  Certainly social security has not entirely displaced all other retirement options.  We’d still buy our food, our toys, our homes, etc. etc. etc. from corporations and individuals rather than the state.  Maybe even our cars.  The difference would be that we’d have our health care taken care of, so instead of health concerns and catastrophes looming over us, we’d be more confident in our roles as consumers elsewhere, more capable of saving, and so on and so forth.  Universal health care would not turn the United States into a socialist nation.  It would only transform one aspect of the private sphere into a social service.

• Is health care coverage really so great even for the insured?  People talk about long lines and subpar service under a single payer or socialized system, but that already seems to be the case now.  I go to see a doctor I usually have to either set up an appointment ahead of time or wait in an emergency room.  When I do see a doctor I get very little time with them.  I think it depends on the insurance but they all limit how much time the doctors will actually be paid to sit and talk with me, so it’s always brief.  I see mostly nurses or other assistants.

• There are many different ways that this can be done, and we need to look toward other nations so we can borrow some of their good ideas.  Germany has a really good system that is not free for everyone and utilizes sliding cost scales, semiprivate insurers, and so forth and includes mandates that everyone is covered.  The UK is completely socialized.  There’s a lot to learn from these systems about what could work for ours if we could ever get past the partisanship.

I suppose, beyond all this, medicine – like education, or crime – seems to be an area wherein profits ought to be secondary.  I know that the accepted argument amongst pro-business types is that competition drives down prices and makes goods more available.  But it certainly hasn’t with health care.  Costs are sky-rocketing, and largely because we’ve taken an area of society that was never meant to be a for-profit industry, and we’ve turned it into one, and in the process we’ve created a lot of unnecessary supply and demand, waste, etc.

I know that red tape and government go hand in hand.  I know that this is a major concern.  Whenever anything gets too big – whether it’s state run or corporate – there is a level of detachment and inefficiency that becomes prevalent.  But the structure as it stands cannot hold.  I’m not sure what the best way forward is, but cries of socialism at the merest whiff of universal health care simply aren’t helping.  We need to reevaluate how we treat this problem.  Not everything having to do with the public or societal or communal good needs to be labeled communist.